Preterm Labour

Question 1

When would you offer a choice between vaginal progesterone and cuz cerclage

Answer 1

Hx of preterm birth or mid-trimester loss between 16 and 34 weeks

AND

Cx length < 25mm between 16 and 24 weeks

Question 2

When would you offer only vaginal progesterone

Answer 2

Cx length <24mm

AND

no Hx of preteen birth or mid trimester loss

Question 3

When would you consider cervical cerclage

Answer 3

Cx length <25mm at 16-24 weeks

AND

Hx of Cx trauma
Or
Hx of PPROM in previous pregnancy

Question 4

What investigations would you do in suspected PROM, no liquor seen

Answer 4

Insulin-like growth factor binding protein-1

Or

Alpha microglobulin 1 test

Results should be interpreted within clinical context

Question 5

Management of PPROM

Answer 5

Erythromycin 250mg qds for 10 days

Penicillin second line

Question 6

When would you consider rescue cerclage

Answer 6

16-27+6

Dilated Cx, exposed & unruptured membranes

Question 7

Management of suspected preterm labour <29+6

Answer 7

Treat as preterm labour

Nifedipine tocoloysis

Question 8

Management for suspected preterm labour >30 weeks

Answer 8

Cx length if available
<15mm treat

If not available

FFN
>50ng/ml treat

If not available offer treatment

Question 9

At what gestation would you consider tocolysis

Answer 9

24-25+6

Intact membranes and suspected preterm labour

Question 10

At what gestation would you offer tocolysis

Answer 10

26 - 33+6

Intact membranes and suspected preterm labour

Question 11

What should be offered as tocolysis

Answer 11

Nifedipine

If contraindicated or unavailable oxytocin receptor antagonists

Do not offer betamimetics

Question 12

Regarding preterm delivery

When would you consider maternal corticosteroids

Answer 12

Suspected or established preterm labour or planned delivery or PPROM

24-25+6

Or

34-35+6

Question 13

Regarding preterm delivery

When would you offer maternal corticosteroids

Answer 13

Suspected or established preterm labour or planned delivery or PPROM

26-33+6

Question 14

When would you offer magnesium sulphate for neuro-protection

Answer 14

Established preterm labour or planned delivery within 24 hours

24-29+6

Question 15

When would you consider magnesium sulphate for neuro-protection

Answer 15

Established preterm labour or planned delivery within 24 hours

30-33+6

Question 16

How is magnesium sulphate for Neuro protection given

What monitoring is required

Answer 16

4g IV over 15 min

1g per hour for 24 hours or until delivery

Check RR, BP and reflexes four hourly

Question 17

Below what gestation should fetal scalp monitoring not be used

At what gestation is discussion requires

Answer 17

<34 weeks

34-36 weeks

Question 18

Below what gestation should FBS not be used

At what gestation is discussion required

Answer 18

<34 weeks

34-36 weeks

Question 19

When should elective Caesarean section for breech be considered

Answer 19

26-36 weeks

Question 20

If preterm babies are stable and there is no significant maternal bleeding, when should the cord be cut

Answer 20

> 30 seconds
<3 minutes

Position baby at level of cord or above it

Question 21

Preterm births account for what % of live births

Answer 21

7.3%

Question 22

What is the single biggest cause of neonatal mortality and morbidity in the U.K.

Answer 22

Preterm birth